Anterior decompression and fixation versus posterior reposition and semirigid fixation in the treatment of unstable burst thoracolumbar fracture: prospective clinical trial.

AIM To compare the anterior and posterior surgical approach in the emergency treatment of unstable burst thoracolumbar fracture. METHODS Twenty-five patients with unstable thoracolumbar fracture underwent either anterior neurodecompression and fixation (n=13) or posterior reposition and semirigid fixation by hook-rod with pedicle screw fixation (n=12), depending on the type of implants available at the time of operation. Neurologically injured patients were operated on within the first 8 hours and neurologically intact patients within the first 2 days after the fracture. Neurological improvement was assessed according to the American Spinal Injury Association grading scale and the Prolo economic/function outcome scale. We also recorded operation time, blood loss, cosmetic outcome, hospital stay and cost, complications, and donor site pain. RESULTS There were no significant differences between the two groups in either neurological improvement (p=0.86) or favorable economic or function outcome (p=0.54 and p=0.53, respectively). The operation time was shorter in the posterior approach group than in the anterior approach group (median 174 min, range 130-215 vs median 250 min, range 200-295, respectively, p<0.001). The blood loss was smaller in the posterior approach group (median 750 mL, range 500-1,10, vs median 1,362 mL, range 1,150-1,50, in the anterior approach group; p<0.001). The posterior approach group also had better esthetic outcome, lower hospital cost, lower complication rate, and no donor site pain. CONCLUSION Both surgical techniques were equally effective in neurological improvement and functional outcome. Posterior surgery can be recommended in emergency neurodecompression and fixation of unstable thoracolumbar fractures because of the shorter operation time and smaller blood loss.